- Email: [email protected]
691: Attrition of first-time faculty in maternal-fetal medicine: is there a difference between men and women?
Poster Session V
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging
stabilize it in place. Placement of a cervical cerclage can then be practiced with standard vaginal cerclage instruments. RESULTS: Cervical cerclage can be practiced using this realistic model. This model is adaptable to allow beginning learners sequential training of increasing difficulty. Removal of all foam “vaginal inserts” allows novices a greater operative field. The procedure can be made increasingly more difficult by sequentially limiting the operative field by adding in more tissue to the vaginal sidewalls. Additional variables can be adjusted in this model including vaginal length, vaginal caliber, and the angle of the pubic arch to simulate the varying difficulties encountered when placing a cerclage in clinical practice. CONCLUSIONS: This low-cost and realistic task trainer can provide Maternal Fetal Medicine Fellows and Obstetric residents the opportunity to practice cervical cerclage placement in a non-clinical environment. This model will enhance learning, reinforce acquired skills, and improve patient safety.
690 Toll-like receptor 1 and Toll-like receptor 5 expression is down-regulated on maternal neutrophils in preeclampsia Joshua Nitsche1, Wendy White1, Jonathan O’Brien1, Carl Rose1, Norman Davies1, William Watson1, Brian Brost1 1
Mayo Clinic College of Medicine, Rochester, MN
OBJECTIVE: Our lab has previously shown that maternal neutrophil
mRNA expression of Toll-like receptor-2 (TLR2) and TLR4 is downregulated in preeclampsia; however, little is known about the impact of preeclampsia on other members of the TLR family. The goal of this study is to determine if maternal neutrophil mRNA expression of TLR1 and TLR5 is altered in women with preeclampsia compared to normal pregnant controls. STUDY DESIGN: After IRB approval, women with mild preeclampsia at term and normal pregnant controls at similar gestational ages were enrolled in the study. Peripheral venous blood was drawn, neutrophils isolated, total RNA extracted, and cDNA copies made. Real time quantitative PCR was then performed and expression relative to GAPDH was calculated using the formula 2^-[(TLR)-(GAPDH)]. After logarithmic transformation, TLR expression was compared between preeclamptic patients and normal pregnant controls using a t-test for independent measures. RESULTS: Demographic data from preeclamptic women and normal pregnant controls is given in Table 1 (mean ⫹/- standard error of the mean). There was significantly lower gravidity (##p⫽0.02) and a trend toward younger maternal age (#p⫽0.06) in preeclamptic women compared to normal pregnant controls. Relative expression of TLR1 and TLR5 are provided in Table 2 (mean ⫹/- standard error of the mean). There was 2.5-fold less TLR1 (*p⫽0.005) and 3.2-fold less TLR5 (**p⫽0.0004) expression in preeclamptic women compared to normal pregnant controls. These differences remained significant after adjusting for differences in maternal age and gravidity between groups. CONCLUSIONS: Previously our lab has demonstrated that TLR2 and TLR4 mRNA expression is down-regulated approximately 3-fold on neutrophils from women with mild preeclampsia. The data here show a similar down-regulation in TLR1 and TLR5. These findings suggest that there may be a global decrease in expression of the entire TLR family. Further study of the remaining TLR’s will be required to confirm this and to fully understand the changes in the innate immune system that occur in preeclampsia.
S274
www.AJOG.org
Table 1. Demographic data
Control (n⫽12)
Gestational Age Maternal Age
Gravidity
Parity
38.6⫹/-0.4
2⫹/-1
1⫹/-1
30.1⫹/-1.6
..........................................................................................................................................................................................
Preeclampsia (n⫽10) 38.7⫹/-0.5 25.7⫹/-1.4# 1⫹/-1## 1⫹/-1 ..........................................................................................................................................................................................
Table 2. TLR Expression
Control (n⫽12)
TLR1
TLR5
3.6⫹/-0.4
0.45⫹/-0.09
..........................................................................................................................................................................................
Preeclampsia (n⫽10) 1.4⫹/-0.5* 0.14⫹/-0.04** ..........................................................................................................................................................................................
691 Attrition of first-time faculty in maternal-fetal medicine: is there a difference between men and women? Sharon Phelan1, Lesley de la Torre1, Ronald Schrader1, Yolanda Gener2, Anne Fullilove1, William Rayburn1 1
University of New Mexico School of Medicine, Albuquerque, NM, Association of American Medical Colleges, Washington, DC
2
OBJECTIVE: According to the Association of American Medical Colleges (AAMC), the departure from academic medicine (or attrition) is more common among women than men faculty in clinical departments. The objective of this long-term investigation was to determine whether this difference existed among faculty in maternal-fetal medicine. STUDY DESIGN: In 1981, the AAMC Faculty Roster began collecting data about maternal-fetal medicine faculty prospectively from each medical school. Data were analyzed for each full-time physician employed at the 125 medical schools. Attrition rates at five and 10 years and fitted attrition (i.e. survival) curves were calculated for first-time faculty beginning their appointments during each of three decade periods (1981-9, 1990-9, 2000-9) to compare probabilities of leaving. RESULTS: Women constituted 35.1% (n ⫽ 193) of full-time faculty in academic maternal-fetal medicine. Attrition from academia was not higher for women than men by 5 years (25.5% vs. 26.3%; p ⫽ 0.56) and by 10 years (41.9% vs. 36.7%; p ⫽ 0.31). Attrition curves demonstrate that the probability of leaving was more common in recent years, regardless of gender (p ⬍ .01). Women tended to leave slightly earlier than men (peak: 4-5 years versus 5-6 years). CONCLUSIONS: Attrition of first-time faculty in maternal-fetal medicine is more common in recent years but was no greater among women than men.
692 Improved performance, knowledge and confidence among maternal fetal medicine staff after maternal cardiac arrest simulation-based training Nelli Fisher1, Lewis A. Eisen2, Jyothshna Bayya3, Peter S. Bernstein1, Alina Dulu2, Leora Goodman1, Irwin R. Merkatz1, Dena Goffman1 1 Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 2Albert Einstein College of Medicine, Bronx, NY, 3Maimonides Medical Center, Brooklyn, NY
OBJECTIVE: To determine the impact of simulation-based maternal code educational program on post-intervention performance, knowledge and confidence among Maternal Fetal Medicine (MFM) Staff at our institution. MFM staff(N⫽19) participated in a maternal code educational simulation program. At pre-intervention simulation, attendings(N⫽ 12) and fellows(N⫽7) were individually introduced to an unresponsive pregnant patient and were expected to manage the emergency. An intervention consisted of a BLS course, ACLS pregnancy modification lecture and a simulation practice session. Interval post-intervention evaluative simulations were performed. Pre and post-intervention simulations included a multiple choice test, attitudes/confidence survey and individualized debriefing. A checklist was used for scoring performance. Maternal(9 pregnancy modification tasks), critical care(16 tasks) and total performance (N⫽25)
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging
stabilize it in place. Placement of a cervical cerclage can then be practiced with standard vaginal cerclage instruments. RESULTS: Cervical cerclage can be practiced using this realistic model. This model is adaptable to allow beginning learners sequential training of increasing difficulty. Removal of all foam “vaginal inserts” allows novices a greater operative field. The procedure can be made increasingly more difficult by sequentially limiting the operative field by adding in more tissue to the vaginal sidewalls. Additional variables can be adjusted in this model including vaginal length, vaginal caliber, and the angle of the pubic arch to simulate the varying difficulties encountered when placing a cerclage in clinical practice. CONCLUSIONS: This low-cost and realistic task trainer can provide Maternal Fetal Medicine Fellows and Obstetric residents the opportunity to practice cervical cerclage placement in a non-clinical environment. This model will enhance learning, reinforce acquired skills, and improve patient safety.
690 Toll-like receptor 1 and Toll-like receptor 5 expression is down-regulated on maternal neutrophils in preeclampsia Joshua Nitsche1, Wendy White1, Jonathan O’Brien1, Carl Rose1, Norman Davies1, William Watson1, Brian Brost1 1
Mayo Clinic College of Medicine, Rochester, MN
OBJECTIVE: Our lab has previously shown that maternal neutrophil
mRNA expression of Toll-like receptor-2 (TLR2) and TLR4 is downregulated in preeclampsia; however, little is known about the impact of preeclampsia on other members of the TLR family. The goal of this study is to determine if maternal neutrophil mRNA expression of TLR1 and TLR5 is altered in women with preeclampsia compared to normal pregnant controls. STUDY DESIGN: After IRB approval, women with mild preeclampsia at term and normal pregnant controls at similar gestational ages were enrolled in the study. Peripheral venous blood was drawn, neutrophils isolated, total RNA extracted, and cDNA copies made. Real time quantitative PCR was then performed and expression relative to GAPDH was calculated using the formula 2^-[(TLR)-(GAPDH)]. After logarithmic transformation, TLR expression was compared between preeclamptic patients and normal pregnant controls using a t-test for independent measures. RESULTS: Demographic data from preeclamptic women and normal pregnant controls is given in Table 1 (mean ⫹/- standard error of the mean). There was significantly lower gravidity (##p⫽0.02) and a trend toward younger maternal age (#p⫽0.06) in preeclamptic women compared to normal pregnant controls. Relative expression of TLR1 and TLR5 are provided in Table 2 (mean ⫹/- standard error of the mean). There was 2.5-fold less TLR1 (*p⫽0.005) and 3.2-fold less TLR5 (**p⫽0.0004) expression in preeclamptic women compared to normal pregnant controls. These differences remained significant after adjusting for differences in maternal age and gravidity between groups. CONCLUSIONS: Previously our lab has demonstrated that TLR2 and TLR4 mRNA expression is down-regulated approximately 3-fold on neutrophils from women with mild preeclampsia. The data here show a similar down-regulation in TLR1 and TLR5. These findings suggest that there may be a global decrease in expression of the entire TLR family. Further study of the remaining TLR’s will be required to confirm this and to fully understand the changes in the innate immune system that occur in preeclampsia.
S274
www.AJOG.org
Table 1. Demographic data
Control (n⫽12)
Gestational Age Maternal Age
Gravidity
Parity
38.6⫹/-0.4
2⫹/-1
1⫹/-1
30.1⫹/-1.6
..........................................................................................................................................................................................
Preeclampsia (n⫽10) 38.7⫹/-0.5 25.7⫹/-1.4# 1⫹/-1## 1⫹/-1 ..........................................................................................................................................................................................
Table 2. TLR Expression
Control (n⫽12)
TLR1
TLR5
3.6⫹/-0.4
0.45⫹/-0.09
..........................................................................................................................................................................................
Preeclampsia (n⫽10) 1.4⫹/-0.5* 0.14⫹/-0.04** ..........................................................................................................................................................................................
691 Attrition of first-time faculty in maternal-fetal medicine: is there a difference between men and women? Sharon Phelan1, Lesley de la Torre1, Ronald Schrader1, Yolanda Gener2, Anne Fullilove1, William Rayburn1 1
University of New Mexico School of Medicine, Albuquerque, NM, Association of American Medical Colleges, Washington, DC
2
OBJECTIVE: According to the Association of American Medical Colleges (AAMC), the departure from academic medicine (or attrition) is more common among women than men faculty in clinical departments. The objective of this long-term investigation was to determine whether this difference existed among faculty in maternal-fetal medicine. STUDY DESIGN: In 1981, the AAMC Faculty Roster began collecting data about maternal-fetal medicine faculty prospectively from each medical school. Data were analyzed for each full-time physician employed at the 125 medical schools. Attrition rates at five and 10 years and fitted attrition (i.e. survival) curves were calculated for first-time faculty beginning their appointments during each of three decade periods (1981-9, 1990-9, 2000-9) to compare probabilities of leaving. RESULTS: Women constituted 35.1% (n ⫽ 193) of full-time faculty in academic maternal-fetal medicine. Attrition from academia was not higher for women than men by 5 years (25.5% vs. 26.3%; p ⫽ 0.56) and by 10 years (41.9% vs. 36.7%; p ⫽ 0.31). Attrition curves demonstrate that the probability of leaving was more common in recent years, regardless of gender (p ⬍ .01). Women tended to leave slightly earlier than men (peak: 4-5 years versus 5-6 years). CONCLUSIONS: Attrition of first-time faculty in maternal-fetal medicine is more common in recent years but was no greater among women than men.
692 Improved performance, knowledge and confidence among maternal fetal medicine staff after maternal cardiac arrest simulation-based training Nelli Fisher1, Lewis A. Eisen2, Jyothshna Bayya3, Peter S. Bernstein1, Alina Dulu2, Leora Goodman1, Irwin R. Merkatz1, Dena Goffman1 1 Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 2Albert Einstein College of Medicine, Bronx, NY, 3Maimonides Medical Center, Brooklyn, NY
OBJECTIVE: To determine the impact of simulation-based maternal code educational program on post-intervention performance, knowledge and confidence among Maternal Fetal Medicine (MFM) Staff at our institution. MFM staff(N⫽19) participated in a maternal code educational simulation program. At pre-intervention simulation, attendings(N⫽ 12) and fellows(N⫽7) were individually introduced to an unresponsive pregnant patient and were expected to manage the emergency. An intervention consisted of a BLS course, ACLS pregnancy modification lecture and a simulation practice session. Interval post-intervention evaluative simulations were performed. Pre and post-intervention simulations included a multiple choice test, attitudes/confidence survey and individualized debriefing. A checklist was used for scoring performance. Maternal(9 pregnancy modification tasks), critical care(16 tasks) and total performance (N⫽25)
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011